Alcohol and Drugs

Alcohol

In Australia, drinking alcohol is an acceptable form of socialising and relaxation. A glass of beer can satisfy a genuine thirst, whilst a glass of wine can make a meal more pleasurable. Going to the pub means contact with friends, and social life is important for everyone.

The relationship of alcohol to epilepsy and seizures is complex, and some people are more vulnerable to the effects of alcohol than others. Some common questions that people with epilepsy ask are:

Can Alcohol Cause Seizures?

Some people with epilepsy can enjoy a drink or two, whilst others find they are unable to tolerate alcohol at all. Studies have shown that small to modest amounts of alcohol do not cause seizures or drastically change the blood levels of antiepileptic medications.

The effects of alcohol differ greatly from person to person but adults with epilepsy should be able to drink alcohol in small amounts (one to two drinks per occasion) if they wish. Some people find if they drink low alcohol products alternate non-alcoholic drinks, it is possible to have a drink or two when socialising.

NOTE: Alcohol is a substance that can cause or worsen seizures when associated with alcoholism or ‘binge’ drinking. Seizures related to alcohol abuse are encountered more commonly than with any other form of substance abuse.

Can I Drink Alcohol?

Medical opinions vary on whether a person with epilepsy can drink alcohol. Some doctors recommend that alcohol should always be avoided, while others say a moderate amount in most cases will do no harm.

It is up to the individual person to decide what suits them and to discuss any issues with their doctor.

If you have had a reaction or an increase in seizures in relation to alcohol in the past, then it is best to avoid it.

How do Alcohol Related Seizures Occur?

Most alcohol related seizures are seen with alcohol withdrawal – usually when a chronic drinker or alcoholic stops drinking, but they can also happen after a binge. These seizures mostly occur within the first 36 to 72 hours of stopping drinking. If they happen frequently, they may lead to developing epilepsy and chronic seizures

When someone has ingested large amounts of alcohol (binge drinking) and the concentration in the bloodstream is poisonous or toxic to the body, a seizure may happen

Drinking large amounts of alcohol will create an imbalance of fluids and electrolytes in the body and has a dehydrating effect. In some circumstances, this may cause a seizure

A seizure may happen after head trauma – head injuries that may occur from accidents or falls while drunk

Chronic alcohol abuse will prevent the absorption of vitamins and is often associated with poor diet and poor health can contribute to poor seizure control

Sometimes people mix alcohol with other substances, and this may also increase the risk of seizures.

How do Alcohol and Antiepileptic Medication Mix?

People taking medications for epilepsy are likely to be more sensitive to the effects of alcohol.

Alcohol can:

Interfere with the absorption of antiepileptic medications, making them less effective

Worsen the side effects of these medications

Some antiepileptic medications can enhance the effects of alcohol so feeling intoxicated after a small amount of alcohol is quite common.

Taking extra medication or changing the time of taking regular medications before drinking will not change this reaction and may cause additional side effects or seizures.

Good practice

People need to practice care when drinking alcohol because:

Alcohol can mix with antiepileptic medications preventing them from reaching the necessary levels in the bloodstream to control seizures

Large amounts of alcohol can trigger seizures as can large intake of non-alcoholic fluids. Both create an imbalance of fluid and electrolytes within the body by either dehydration or overhydration

Alcohol consumption is often associated with late nights, poor sleep quality, missed meals and forgotten medications, all of which can trigger seizures.

What is moderate drinking?

The distinction between ‘social’ drinking and ‘problem’ drinking can be very unclear. The National Health and Medical Research Council (NHMRC) suggests for healthy men and women, drinking no more than two standard drinks on any day (reduces the lifetime risk of harm from alcohol-related disease or injury). This recommendation is for healthy individuals. However, having a chronic health condition such as epilepsy can alter what is considered “safe” drinking.

Many people with epilepsy choose to drink considerably less than these recommended limits. Many find that by drinking no alcohol at all, greater seizure control is achieved.

For more information

Recreational Drugs

No recreational drug is harmless. These drugs can be made up of many different substances of unknown quantity. They are illegal and there are no regulations to control quality. Like alcohol, each person will have different reactions to various drugs.

Many illicit drugs, especially stimulants such as cocaine, ecstasy, crystal meth and speed (amphetamines), have the potential to cause seizures and it is uncertain what interactions these, or any recreational drugs, may have with prescription medicines. As the name suggests, stimulants are types of drugs that enhance brain activity causing an increase in alertness, attention, and energy. Other illicit drugs such as depressants and hallucinogens can also cause problems. Be aware that high-energy drinks can also be harmful.

Drug taking is also associated with problems such as not getting enough sleep, dehydration, and not eating properly. These in themselves are common triggers of seizures.

The decision to use illicit drugs is a personal one, but it is important to be aware that there is an increased risk of seizures and this is further increased if more than one drug is taken or it is mixed with alcohol or high-energy drinks.

One can never predict what side effects will be experienced in mixing antiepileptic drugs and other drugs. This is true for prescribed and non-prescribed medication.

Also remember that the recreational use of these substances is illegal in Australia.

Cannabis

Cannabis is a frequently used recreational drug. It is now used in a different form for medicinal purposes to reduce nausea and vomiting caused by some anticancer treatments, or with AIDs patients. The medicinal form has different components than the recreational form of cannabis.

Is it a Useful Anti-epileptic Drug?

The recreational form of cannabis contains high levels of THC which is the component that causes a “high” and many other effects. This type of cannabis can have a range of effects and potency, so it is not recommended to be used as an antiepileptic agent.

Research about the effects of a medicinal form of cannabis on seizure activity is continuing.

There are significant differences in the composition and administration of recreational cannabis and medicinal cannabis.

Recreational cannabis use in Australia is not legal and therefore not recommended as an antiepileptic agent.

Is it Dangerous for People with Epilepsy to use Cannabis?

Recreational use can impair short-term memory for short periods, and, like alcohol use, may increase the risk of not taking or forgetting to take antiepileptic drugs. It has also been linked with effects on mental health. Recreational cannabis use and withdrawal could potentially trigger seizures in susceptible people.

Some studies and anecdotal reports show that high doses of cannabis can trigger seizures.

Ecstasy

Ecstasy (MDMA) is a commonly used club drug. It is an illegal synthetic drug that is both a nervous system stimulant and a hallucinogen and in high doses can cause seizures and vomiting.

Ecstasy may also contribute to death as a result of heart attack, stroke, overheating or if a person drinks too much water.

Taking ecstasy can lead to other seizure triggers such as sleep deprivation and dehydration. This may be because of being hyperactive and, for example, dancing all night. Problems may arise if someone with epilepsy starts to drink excessive amounts of water as this can lead to water intoxication, which in turn could cause changes in consciousness or a seizure.

Amphetamines and Methamphetamines (speed, ice)

Amphetamine is an addictive stimulant drug that abnormally speeds up the functions of the brain and body. There are many health effects associated with amphetamines including increased wakefulness increased physical activity, decreased appetite, increased breathing rate, fever and euphoria. Other effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Fever and convulsions can result in death. (NIDA USA)

As amphetamines are a stimulant, people may use them to keep themselves awake, for example, if they were going clubbing until the early hours of the morning. The resulting lack of sleep can be a trigger factor for many people with epilepsy. Long term misuse can damage the brain and may lead to psychosis, malnutrition and violent behaviour.

Heroin

Heroin is not a stimulant but a depressant, and although it is associated with many serious health problems, seizures are not common. More often, seizures may be related to taking other drugs or alcohol at the same time or to the overall effect of a heroin overdose. As heroin can be administered in the veins, some people may experience seizures as a result of serious infection from using dirty needles or impurities in the drug.

People with epilepsy seeking helping for heroin addiction should discuss their treatment medication with their doctor.

Cocaine (coke, crack)

Cocaine can is a stimulant and can provoke seizures in people who don’t have epilepsy, as well as making someone’s epilepsy worse. Cocaine can lower the seizure threshold, or cause other medical problems, which can lead to seizures. Seizures can also occur as an indirect result of taking cocaine such as lack of sleep, lack of food and not taking anti-epileptic medication as prescribed.

Inhalants

Inhalants are chemical substances that give off fumes and sometimes inhaled to become “high”. These include solvents like petrol, cleaning fluids, paints, liquid shoe polish, nail polish remover, and glue; aerosols like spray paint, insecticides, and hair spray; and anaesthetics like nitrous oxide (laughing gas). These chemicals temporarily stimulate before they depress the brain (central nervous system).

Evidence suggests that long term use of inhalants can cause brain/nervous system damage, which may cause epilepsy. There is also a strong possibility that sniffing solvents over a longer period of time could make someone’s epilepsy worse.

Steroids

These are synthetic drugs sometimes used by athletes and body builders. Although anabolic steroids are used in the treatment of some health conditions, abuse or long term use of these drugs can lead to some irreversible health problems. There is no evidence to suggest that steroids used in some sporting activities can trigger or provoke seizures.

Tobacco/Nicotine

Nicotine is both a stimulant and a depressant to the central nervous system. Although it is associated with many serious health effects, there is no evidence to suggest that smoking cigarettes or cigars trigger seizures in people with epilepsy. However, some nicotine preparations used to help people stop smoking, should be used with caution as they can have a side effect of seizures.

If someone with epilepsy wants to stop smoking, before buying any nicotine preparations, discuss this further with their doctor.